Organization Name: | JO-ANN N. BOLLI, M. D., P.S.C. |
NPI Number: | 1003153321 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JO-ANN NADEAU BOLLI (OWNER) |
Mailing Address: | 308 S Washington St Suite 201 Clinton |
State: | KY US |
Postal Code: | 420311340 |
Phone Number: | 2706534070 |
Fax Number: | 2706534007 |
NPI Enumeration Date: | 01/07/2013 |
NPI Last Update Date: | 01/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 28789 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |